What is Self-Direction

Self-Direction is a model of long-term care service delivery that helps people of all ages, with all types of disabilities, maintain their independence at home. When a person self-directs, they decide how, when, and from whom their services and supports will be delivered.

As a model, self-direction prioritizes participant choice, control, and flexibility. This contrasts with "traditional" services received from an agency, where the agency controls most aspects of service delivery, including who will provide the service.

In self-direction, the participant selects and trains their own staff, develops their staff's schedules, and sets their own standards for how their services will be delivered. Self-directed services are a flexible, person-centered, and cost-effective alternative to nursing homes and other institutional settings.

Hallmarks of Self-Direction

Flexible, Person-Centered, and Cost-Effective

Self-directed services are a flexible, person-centered, and cost-effective alternative to nursing homes, other institutional settings, and more traditional, agency-driven home and community-based services.

  • In self-direction, typically the participant is the legal employer of their staff.
  • Participants often choose to hire family members and friends to provide needed services.
  • Often, states also include options to purchase goods and services that can reduce the individual's need for ongoing services. For example, a participant who uses a wheelchair might choose to purchase a front-facing washing machine and dryer, which would reduce their ongoing need for a worker to assist with laundry.
  • In Medicaid programs, the specific services and supports that can be self-directed depend on the state in which the participant lives. Nationally, services that are most often self-directed include personal care, transportation, and respite.

Built-in Guidance and Support

When it comes to being an employer, people who self-direct are not required to figure everything out on their own. Instead, support is available every step of the way. Federal Medicaid rules require certain supports to be in place in Medicaid-funded self-direction. Supports include:

  • Financial Management Services helps participants manage payroll and other administrative responsibilities.
  • Information and Assistance (I&A) helps people develop spending plans based on their budget allocation and learn how to be an effective employer.
  • Representatives are available for any individual who wants to self-direct but is unable or unwilling to perform employer duties themselves. For example, children who self-direct typically have a parent or guardian serve as the employer.

Supports help ensure self-direction is accessible to everyone, regardless of their age or disability.

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